Lupus erythematosus should be viewed as a
continuum of a spectrum of this
autoimmune disease.

At one end of the spectrum, in its most
mild form, it is characterized by
coin-shaped, scarring, skin lesions which
we term discoid lesions.

At the other end of the spectrum are
those systemic lupus erythematosus
patients who have no skin lesions, but
have systemic features.

People with only discoid lesions and no
systemic features commonly have no
auto-antibodies in their serum and their
antinuclear or anti-DNA tests will be
negative.

On the other hand, people with systemic
lupus erythematosus are characterized by
the presence of one or more types of
auto-antibodies in their blood.

From reviewing the literature, it has
been estimated that between 5 and
10% of patients initially
presenting with only the coin-shaped
lesions of discoid lupus will, with time,
develop systemic features.

As noted above, approximately 20%
of people with systemic lupus
erythematosus will at the time
of the initial presentation of their
disease have discoid lupus lesions.

Therefore indicating that with time, a
small percentage of those patients who
only have discoid lupus lesions will
eventually develop systemic disease

In addition to these coin-shaped,
scarring lesions, there are several
different types of discoid lupus lesions
with which patients should be familiar.

The non-specific lupus lesions include
several forms of alopecia, or hair
loss, which are not related to the
presence of discoid lupus lesions in the
scalp.

Systemic lupus patients who have been
severely ill with their disease may over a
period of time, develop a transient hair loss
in which large amounts of hair evolve into a
resting phase and fall out, being quickly
replaced by new hair.

In addition, a severe flare of systemic lupus
erythematosus can result in defective hair
growth which causes the hair to be fragile
and to break easily.

The hair is broken off above the surface of
the scalp, especially at the edge of the
scalp, giving the characteristic appearance
termed "lupus hair".

The use of plastic wrapping over the skin
to increase the absorption of steroid
creams.

Injections of medication in the case of
exceptionally thick skin lesions that
don't respond to creams.

Anti-malarial drugs.

Other medications, such as those used for
psoriasis.

Oral steroids if SLE is also present.

Avoid sun exposure
Staying out of the sun is perhaps the most
crucial strategy for the management of discoid
lupus. The ultraviolet radiation in sunlight can
trigger or worsen an attack. Suggestions include:

Avoid exposing yourself to direct
sunlight whenever possible.

Cover as much of your skin as you can
with clothes such as long-sleeved shirts,
trousers, gloves, broad brimmed hat and
so on.

Always wear sunscreen lotion on all
exposed areas of skin when you go
outside.

Choose sunscreens that protect against
both UVA and UVB.

Wear sunscreen even in winter or on
cloudy days - any degree of ultraviolet
radiation on the skin should be avoided.

Remember that ultraviolet radiation is
not stopped by window glass, and is
reflected off surfaces like concrete,
snow and water.

Some fluorescent tubes emit ultraviolet
radiation.

Wind and cold temperatures may affect
some people with discoid lupus.

Where to get help

Your doctor

Dermatologist

Support Groups (lupus
patients)

Things
to Remember

Discoid lupus is a chronic
skin condition characterised
by reddened scaly patches
that develop in sun-exposed
areas of the body such as the
face and hands.

It is unclear whether discoid
lupus is a separate disease,
or a milder version of
systemic lupus.

Staying out of the sun is
perhaps the most crucial
strategy for the management
of discoid lupus.

Treatment options include
topical steroids and
anti-malarial medication. (however,
be very careful with your
research on meds, as some
have irreversible occular
side effects *for some
patients* -i.e.: chloroquin)